Provider Demographics
NPI:1982819504
Name:GOELZER, WALLACE ALAN (MA, LMFT)
Entity Type:Individual
Prefix:MR
First Name:WALLACE
Middle Name:ALAN
Last Name:GOELZER
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 PEACH PARK LN NW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-4042
Mailing Address - Country:US
Mailing Address - Phone:253-445-1812
Mailing Address - Fax:
Practice Address - Street 1:2501 E D ST STE 213
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98421-1326
Practice Address - Country:US
Practice Address - Phone:253-445-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001777106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist